Final Exam Review Questions
The nurse is assessing a client who has a 35 pack-year history of cigarette smoking. In light of this known risk factor for lung cancer, what statement by the client should prompt the nurse to refer the client for further assessment? a. "Lately, I have this cough that just never seems to go away." b. "I find that I don't have nearly the stamina that I used to." c. "I seem to get nearly every cold and flu that goes around my workplace." d. "I never used to have any allergies, but now I think I'm developing allergies to dust and pet hair."
a. "Lately, I have this cough that just never seems to go away."
An oncology nurse is providing health education for a client who has recently been diagnosed with leukemia. What should the nurse explain about commonalities between all of the different subtypes of leukemia? A. The different leukemias all involve unregulated proliferation of white blood cells. B. The different leukemias all have unregulated proliferation of red blood cells and decreased bone marrow function C. The different leukemias all result in a decrease in the production of white blood cells D. The different leukemias all involve the development of cancer in the lymphatic system.
A. The different leukemias all involve unregulated proliferation of white blood cells.
Which of the following are examples of characteristics of evidence-based practice? SELECT ALL A). It is a problem-solving approach. B). It uses the best evidence available. C). It is generally accepted in clinical practice. D). It is based on current institutional protocols. E). It blends the science and art of nursing
A). It is a problem-solving approach. B). It uses the best evidence available. E). It blends the science and art of nursing
Which statement by a client who has a new diagnosis of non-Hodgkin lymphoma (NHL) demonstrates a sound understanding of the diagnosis and treatment of the health problem? A. "They confirmed my diagnosis with a lymph node biopsy and I'll get radiation treatment soon because it's fairly early stage." B. "They took a sample of my lymph nodes and I'll be having surgery soon that will hopefully cure my lymphoma." C. "My blood work came back positive for NHL, and I'm meeting with my oncologist to discuss chemotherapy soon." D. "Since the tests show NHL, I'm going to pursue my options for palliative care because I'm committed to dying with dignity."
A. "They confirmed my diagnosis with a lymph node biopsy and I'll get radiation treatment soon because it's fairly early stage."
Two years after chemotherapy and radiation therapy for lung cancer, a 72-year-old client reports being extremely tired all the time. The physician suspects the client may have developed aplastic anemia. The nurse assessing the client will likely find which clinical manifestation of aplastic anemia? SELECT ALL. A. Complaints of weakness and fatigue B. Small spots of skin hemorrhages over entire body C. Excess bleeding from gums and nose D. Spoon-shaped deformity of the fingernails E. Hemolysis from renal dialysis treatments
A. Complaints of weakness and fatigue B. Small spots of skin hemorrhages over entire body C. Excess bleeding from gums and nose
This organization is seen at both state and county levels to facilitate mitigation, disaster response and recovery. A. EMA B. FEMA C. HICS D. ICS
A. EMA (emergency management agency)
This is developed by an organization, in order to prepare for an emergency/disaster. A. EOP B. HVA C. CDC D. OEM
A. EOP (emergency operations plan)
A nurse who provides care on an acute medical unit has observed that physicians are frequently reluctant to refer clients to hospice care. What are contributing factors that are known to underlie this tendency? SELECT ALL A. Financial pressures on health care providers B. Client reluctance to accept this type of care C. Strong association of hospice care with prolonging death D. Advances in "curative" treatment in late-stage illness E. Ease of making a terminal diagnosis
A. Financial pressures on health care providers B. Client reluctance to accept this type of care D. Advances in "curative" treatment in late-stage illness
This professional can be utilized at multiple areas and multiple functions A. Nurse B. Volunteer C. Chiropractor D. Police
A. Nurse
An adult oncology client has a diagnosis of bladder cancer with metastasis and the client has asked for the nurse about the possibility of hospice care. Which principle is central to a hospice setting? A. The client and family should be viewed as a single unit B. Persistent symptoms of terminal illness should not be treated C. Each member of the interdisciplinary team should develop an individual plan of care D. Terminally ill clients should die in the hospital whenever possible
A. The client and family should be viewed as a single unit
A Nurse is caring for a terminally ill cancer client who is being transferred to hospice care. Which information regarding hospice care would the nurse include in the teaching plan? Select all that apply A. The focus of care is on controlling symptoms and relieving pain. B. A multidisciplinary team provides care. C. Services are provided based on third-party insurance reimbursement D. Hospice care is provided only in hospice centers E. Bereavement care is provided to the family
A. The focus of care is on controlling symptoms and relieving pain. B. A multidisciplinary team provides care. E. Bereavement care is provided to the family
The nurse considers the provisions of palliative care, which are to __________. SELECT ALL A. Treat symptoms of pain, dyspnea, and nausea B. Provide CPR C. Provide mechanical ventilation D. Enable the patient to have a better quality of life
A. Treat symptoms of pain, dyspnea, and nausea D. Enable the patient to have a better quality of life
A client presents to the ED reporting severe substernal chest pain radiating down his left arm. He is admitted to the coronary care unit (CCU) with a diagnosis of myocardial infarction (MI). What nursing assessment activity is a priority on admission to the CCU? A.Begin ECG monitoring. B.Obtain information about family history of heart disease. C.Auscultate lung fields. D.Determine if the client smokes.
A.Begin ECG monitoring.
A client who develops acute respiratory distress syndrome (ARDS) is exhibiting hypoxemia unresponsive to oxygen therapy. In explaining the client's condition to the family, the nurse would incorporate which concept? A.Blood is shunted past alveoli with no ventilation B.The individual has difficulty expelling air trapped in the alveoli. C.There is excess surfactant production by the alveoli. D.Thick secretions block the airways
A.Blood is shunted past alveoli with no ventilation
The nurse is caring for a client newly diagnosed with human immune deficiency virus (HIV) obtained from unprotected sex. The nurse is in the room when the client is explaining the disease to another person. Which statement by the client would the nurse clarify? SELECT ALL A. "My sexual practices will have to change." B. "I am afraid that I will give this disease to my nephew." C. "The disease can also be spread by body fluids." D. "I could pass this on to a baby before I give birth." E. "Medications can cure the disease."
B. "I am afraid that I will give this disease to my nephew." E. "Medications can cure the disease."
The nurse is performing a neurologic assessment of a client whose injuries have rendered her unable to follow verbal commands. How should the nurse proceed with assessing the client's level of consciousness (LOC)? A Assess the client's vital signs and correlate these with the client's baselines B. Assess the client's eye opening and response to stimuli C. Document that the client currently lacks a level of consciousness D. Facilitate diagnostic testing in an effort to obtain objective data
B. Assess the client's eye opening and response to stimuli
A patient with poorly controlled diabetes has developed end-stage renal failure and consequent anemia. When reviewing this patient's treatment plan, the nurse should anticipate the use of what drug? A. Magnesium sulfate B. Epoetin alfa C. Low-molecular weight heparin D. Vitamin K
B. Epoetin alfa
A 48-year-old man who has been HIV positive for 6 years has just learned that he has been diagnosed with Kaposi sarcoma (KS). Which fact most accurately conveys an aspect of his diagnosis? A. An opportunistic Epstein-Barr virus underlies the man's KS. B. He is likely to have lesions on his skin, mouth, or GI tract. C. Intense pain was probably his first manifestation of KS D. Heterosexual contact most likely underlies his HIV and subsequent KS.
B. He is likely to have lesions on his skin, mouth, or GI tract.
A nurse is caring for a client who has a diagnosis of acute leukemia. What assessments usually are NOT a cause of death among clients with leukemia? SELECT ALL A. Monitoring for infection B. Monitoring nutritional status C. Monitoring electrolyte levels D. Monitoring liver function
B. Monitoring nutritional status C. Monitoring electrolyte levels D. Monitoring liver function
The nurse is assessing a 28-year-old man with HIV who has been admitted with pneumonia. In assessing the patient, which of the following observations takes immediate priority? A. Oral temperature of 100°F B. Tachypnea and restlessness C. Frequent loose stools. D. Weight loss of 1 pound since yesterday
B. Tachypnea and restlessness
True or False: When determining the appropriate size of an oropharyngeal airway (OPA) it should be as long as the distance from the tip of the patient's nose to the earlobe?
False
A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which aspect of her condition would help to rule out Hodgkin lymphoma? A. Her neoplasm originates in secondary lymphoid structures. B. The lymph nodes involved are located in a large number of locations in the lymphatic system. C. The presence of Reed-Sternberg cells has been confirmed. D. The woman complains of recent debilitating fatigue.
B. The lymph nodes involved are located in a large number of locations in the lymphatic system.
A client was tested for HIV as part of a screening process and has just been told that the results were positive. What anticipatory guidance should the nurse provide to the client? A. The client will be retested for HIV in 6 weeks and in 3 months B. Antiretroviral therapy will begin within 3 months C. A follow-up test will be promptly performed to confirm the result D. The client will be monitored for signs and symptoms of HIV infection to determine if treatment is necessary
C. A follow-up test will be promptly performed to confirm the result
Disaster triage colors in order of priority from highest to lowest. A. Black, Red, Green, Yellow B. Red, Orange, Black, Green C. Red, Yellow, Green, Black D. White, Grey, Pink, Blue
C. Red, Yellow, Green, Black
The nurse is caring for an adult client recently diagnosed with the early stages of lung cancer. The nurse is aware that the preferred method of treating clients with non-small cell tumors is what? A. Chemotherapy B. Radiation C. Surgical resection D. Bronchoscopic opening of the airway
C. Surgical resection
Which assessment data would indicate the client diagnosed with Acute Respiratory Distress Syndrome (ARDS) is experiencing a complication secondary to the ventilator? A. The client's urine output is 210 mL in 8 hours. B. The pulse oximeter reading is greater than 95%. C. The client has asymmetrical chest expansion. D. The telemetry reading shows sinus tachycardia.
C. The client has asymmetrical chest expansion.
The nurse is caring for a patient who has just had a radical mastectomy and axillary node dissection. When doing patient education, what should be included regarding hand and arm care of the affected side? A.Avoid exercise of the arm. B.Keep cuticles clipped. C.Avoid lifting objects greater than 5-10 pounds D.Use a sunscreen with an SPF of 4 to 8.
C.Avoid lifting objects greater than 5-10 pounds
An 18-year-old pregnant female has tested positive for HIV and asks the nurse if her baby is going to be born with HIV. What is the nurse's best response? A."There is no way to know that for certain, but we do know that your baby has a one in four chance of being born with HIV." B."Your physician is likely the best one to ask that question." C."If the baby is HIV positive there is nothing that can be done until it is born, so try your best not to worry about it now." D. "It's possible that your baby could contract HIV, either before, during, or after"
D. "It's possible that your baby could contract HIV, either before, during, or after"
A patient has been living with a diagnosis of anemia for several years and has experienced recent declines in her hemoglobin levels despite active treatment. What assessment finding would signal complications of anemia? A. Venous ulcers and visual disturbances B. Fever and signs of hyperkalemia C. Epistaxis and gastroesophageal reflux D. Ascites and peripheral edema
D. Ascites and peripheral edema
The medical nurse is aware that patients with sickle cell anemia benefit from understanding what situations can precipitate a sickle cell crisis. When teaching a patient with sickle cell anemia about strategies to prevent crises, what measures should the nurse recommend? A. Using prophylactic antibiotics and performing meticulous hygiene. B. Maximizing physical activity and taking OTC iron supplements C. Limiting psychosocial stress and eating a high-protein diet D. Avoiding cold temperatures and ensuring sufficient hydration
D. Avoiding cold temperatures and ensuring sufficient hydration
The nurse is caring for a client who has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The client states that he would like to die at home, but the team believes that the client's care needs are unable to be met in a home environment. What might the nurse suggest as an alternative? A. Discuss a referral for rehabilitation hospital. B. Panel the client for a personal care home. C. Discuss a referral for acute care. D. Discuss a referral for hospice care.
D. Discuss a referral for hospice care.
This person is in charge of a disaster scene. A. Highest ranking officer from any organization B. Fire chief C. RN on the scene D. Incident Commander
D. Incident Commander
A patient is admitted to the hospital with pernicious anemia. The nurse should prepare to administer which of the following medications? A. Folic acid B. Vitamin B12 C. Lactulose D. Magnesium sulfate
Vitamin B12
The nurse is caring for a client admitted with angina who is scheduled for cardiac catheterization. The client is anxious and asks the reason for this test. What is the best response? a. "Cardiac catheterization is usually done to assess how blocked or open a client's coronary arteries are." b. "Cardiac catheterization is most commonly done to detect how efficiently a client's heart muscle contracts." c. "Cardiac catheterization is usually done to evaluate cardiovascular response to stress." d. "Cardiac catheterization is most commonly done to evaluate cardiac electrical activity."
a. "Cardiac catheterization is usually done to assess how blocked or open a client's coronary arteries are."
A nurse is conducting a neurological assessment of a patient who has just been admitted to the unit. In preparation for assessing the patient for pronator drift, what instructions should the nurse provide to the patient? a. "Please hold your arms straight out with your eyes closed." b. Please close your eyes and then walk a few steps with one foot directly in front of the other." c. "Please close your eyes and then touch the tip of your nose with one index finger and then the other." d. "Please lift one leg a few inches off the bed and hold it as still as possible."
a. "Please hold your arms straight out with your eyes closed."
The nurse providing care for a client post PTCA knows to monitor the client closely. For what complications should the nurse monitor the client? SELECT ALL a. Abrupt closure of the coronary artery b. Venous insufficiency c. Bleeding at the insertion site d. Retroperitoneal bleeding e. Arterial occlusion
a. Abrupt closure of the coronary artery c. Bleeding at the insertion site d. Retroperitoneal bleeding e. Arterial occlusion
An emergency department nurse has just received a client with burn injuries brought in by ambulance. The paramedics have started a large-bore IV and covered the burn in cool towels. The burn is estimated as covering 24% of the client's body. How should the nurse best address the pathophysiologic changes resulting from major burns during the initial burn-shock period? a. Administer IV fluids b. Administer broad-spectrum antibiotics c. Administer IV potassium chloride d. Administer packed red blood cells
a. Administer IV fluids
After an assessment, the nurse identifies that a female client is at risk for the development of colorectal cancer. Which non-modifiable risk factors did the nurse assess to make this clinical determination? Select all that apply. a. Age 53 b. Smokes cigarettes c. Sedentary lifestyle d. African American race e. Treatment for type 2 diabetes mellitus
a. Age 53 d. African American race
1.) The clinic leader tends to make decisions independently and closes watches and controls the practice of the nurses in the clinic. What kind of leadership does this exemplify? a. Authoritarian b. Democratic c. Laissez Faire d. A contingency approach
a. Authoritarian
The nurse caring for a client in a persistent vegetative state is regularly assessing for potential complications. The nurse should assess for which complications? SELECT ALL a. Contractures b. Hemorrhage c. Venous thromboembolism d. Pneumonia
a. Contractures b. Hemorrhage c. Venous thromboembolism d. Pneumonia
Your patient is in cardiac arrest. You have started compressions and the monitor has determined the patient is in pulseless ventricular tachycardia. Your next step is: a. Defibrillate b. Epinephrine 1 mg IV push c. Amiodarone 300 mg IV push d. Transcutaneous Pacing
a. Defibrillate
1.) A nurse is being sued for malpractice in a court of law. What elements must be established to prove that malpractice or negligence has occurred? Select all that apply. a. Duty b. Intent to harm c. Breach of Duty d. Causation e. Punitive damages f. Fraud
a. Duty c. Breach of Duty d. Causation
A client has been admitted to a burn intensive care unit with extensive full-thickness burns over 25% of the body. After ensuring cardiopulmonary stability, what would be the nurse's immediate, priority concern when planning this client's care? a. Fluid status b. Risk of infection c. Nutritional status d. Psychosocial coping
a. Fluid status
In an acute care setting, the nurse is assessing an unstable client. When prioritizing the client's care, the nurse should recognize that the client is at risk for hypovolemic shock in which of the following circumstances? a. Fluid volume circulating in the blood vessels decreases. b. There is an uncontrolled increase in cardiac output. c. Blood pressure regulation becomes irregular. d. The client experiences tachycardia and a bounding pulse.
a. Fluid volume circulating in the blood vessels decreases.
Which of the following are possible complications of total parenteral nutrition? SELECT ALL a. Hyperglycemia b. New atrial fibrillation c. Rebound Hypoglycemia d. Fluid overload e. Sepsis
a. Hyperglycemia c. Rebound Hypoglycemia d. Fluid overload e. Sepsis
A group of students is preparing for a quiz on breast cancer and common findings associated with the breast examination. The students demonstrate understanding of the material when they identify which of the following? SELECT ALL a. Irregular firm hard lumps b. Elastic tender mobile lumps c. Dimpling and nipple retraction d. Orange-peel-like appearance e. Redness and warmth with smooth texture f. Breast fullness and pain
a. Irregular firm hard lumps c. Dimpling and nipple retraction d. Orange-peel-like appearance
The nurse is caring for a client who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the client the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? a. Palliative b. Reconstructive c. Salvage d. Prophylactic
a. Palliative
A client is in the acute phase of a burn injury. One of the nursing diagnoses in the plan of care is Ineffective Coping Related to Trauma of Burn Injury. What interventions appropriately address this diagnosis? SELECT ALL a. Promote truthful communication b. Avoid asking the client to make decisions c. Teach the client coping strategies d. Administer benzodiazepines as prescribed e. Provide positive reinforcement
a. Promote truthful communication c. Teach the client coping strategies e. Provide positive reinforcement
A client with cardiovascular disease is being treated with amlodipine, which is intended to cause what therapeutic effect? a. Reducing the heart's workload by decreasing heart rate and myocardial contraction b. Preventing platelet aggregation and subsequent thrombosis c. Reducing myocardial oxygen consumption by blocking adrenergic stimulation to the heart d. Increasing the efficiency of myocardial oxygen consumption, thus decreasing ischemia and relieving pain
a. Reducing the heart's workload by decreasing heart rate and myocardial contraction
The nurse manager is applying an evidence based approach to a clinical question around client mobilization. When using a PICO format to search for evidence, the nurse should identify what? a. The role of intuition in the decision-making process b. The preferences of clients and their families c. The clients for whom the intervention would be relevant d. Costs associated with a potential change in practice
c. The clients for whom the intervention would be relevant
The school nurse is presenting a class on smoking cessation at the local high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response related to risk for lung cancer in smokers is most accurate? a. The younger you are when you start smoking, the higher your risk of lung cancer." b. The risk for lung cancer never decreases once you have smoked, which is why smokers need annual chest x-rays c. "The risk for lung cancer is determined mostly by what type of cigarettes you smoke." d. "The risk for lung cancer depends primarily on the other risk factors for cancer that you have.
a. The younger you are when you start smoking, the higher your risk of lung cancer."
The nurse is doing discharge teaching with a client who has coronary artery disease. The client asks why he has to take an aspirin every day if he doesn't have any pain. What would be the nurse's best response? a. "Taking an aspirin every day is an easy way to help restore the normal function of your heart." b. "An aspirin a day can help prevent some of the blockages that can cause chest pain or heart attacks." c. "Taking an aspirin every day is a simple way to make your blood penetrate your heart more freely." d. "An aspirin a day eventually helps your blood carry more oxygen that it would otherwise."
b. "An aspirin a day can help prevent some of the blockages that can cause chest pain or heart attacks."
Which question would assist the nurse in determining whether the client has been experiencing anxiety? a. "Have you had difficulty concentrating lately?" b. "Have you been feeling sad and especially lonely?" c. "Do you have a history of failed personal relationships?" d. "Do you frequently experience difficulty controlling your anger?"
b. "Have you had difficulty concentrating lately?"
A 53-year-old woman who was diagnosed with breast cancer following a process that began with abnormal screen mammography results. The patient, her oncologist, and surgeon have agreed on a mastectomy as treatment and have discussed the importance of rigorously assessing whether her cancer has metastasized. What action will best detect possible metastasis of the patient's breast cancer? a. Serial bone marrow biopsies b. Biopsy of the axillary lymph nodes c,. Careful grading of the tumor cells d. Gauging her response to radiation therapy
b. Biopsy of the axillary lymph nodes
A nurse in the ICU is planning the care of a client who is being treated for shock. What statement best describes the pathophysiology of this client's health problem? Blood is shunted from vital organs to peripheral areas of the body. b. Cells lack an adequate blood supply and are deprived of oxygen and nutrients. c. Circulating blood volume is decreased with a resulting change in the osmotic pressure gradient. d. Hemorrhage occurs as a result of trauma, depriving vital organs of adequate perfusion.
b. Cells lack an adequate blood supply and are deprived of oxygen and nutrients.
A group of students are reviewing info about EBP in preparation for an exam. The students demonstrate understanding of the information when they identify which the following as associated with EBP? a. It emphasizes personal experience over science b. Clinical expertise is integrated with external evidence c. It involves gaining solutions to problems d. The purpose is to learn about a specific problem
b. Clinical expertise is integrated with external evidence
While completing a health history on a client who has recently experienced a seizure, the nurse would assess for what characteristic associated with the postictal state? a. Epileptic cry b. Confusion c. Urinary incontinence d. Body rigidity
b. Confusion
1.) What kind of leader shares decisions and activities with group participants? a. Laissez Faire b. Democratic c. Autocratic d. Situational
b. Democratic
A nurse in the ICU receives report from the nurse in the ED about a new client being admitted with a neck injury he received while diving into a lake. The ED nurse reports that his blood pressure is 85/54, heart rate is 53 beats per minute, and his skin is warm and dry. What does the ICU nurse recognize that that client is probably experiencing? a. Anaphylactic shock b. Neurogenic shock c. Septic shock d. Hypovolemic shock
b. Neurogenic shock
Which statement accurately applies to personality disorders? a. One aspect of personality is usually involved b. Personality traits are dysfunctional and inflexible c. Patients have subjective distress, but not impaired functioning d. Symptoms have a short duration and are responsive to treatment
b. Personality traits are dysfunctional and inflexible
The nurse is preparing the client for mechanical débridement and informs the client that this will involve which of the following procedures? a spontaneous separation of dead tissue from the viable tissue b. Removal of eschar until the point of pain and bleeding occurs c. Shaving of burned skin layers until bleeding, viable tissue is revealed d. Early closure of the wound
b. Removal of eschar until the point of pain and bleeding occurs
A client has blindness related to conversion disorder but is unconcerned about this problem. Which understanding should guide the nurse's planning for this client? a. The client is suppressing accurate feelings regarding the problem b. The client's anxiety is relieved through the physical symptom c. The client's optic nerve transmission has been impaired d. The client will not disclose genuine fears
b. The client's anxiety is relieved through the physical symptom
Which scenarios are examples of a nurse committing a tort? SELECT ALL a.) the nurse applies a vest restraint to an older adult client who is confused and has an unsteady gait. The client is constantly getting out of their chair. b.) the nurse told the client, "The doctor prescribed this med, and you must take it. I will force you to take it." c.) The nurse tells another employee. "Everyone knows the previous nurse does not do their job and charts meds not administered." d.) The nurse is part of a team who forcibly restrained an out of control patient that was threatening self harm e.) The nurse administered a sedative medication to a sleeping client because the client's child requested the parent receive it.
b.) the nurse told the client, "The doctor prescribed this med, and you must take it. I will force you to take it." c.) The nurse tells another employee. "Everyone knows the previous nurse does not do their job and charts meds not administered." e.) The nurse administered a sedative medication to a sleeping client because the client's child requested the parent receive it.
A critical care nurse is planning assessments in the knowledge that clients in shock are vulnerable to developing fluid replacement complications. For what signs and symptoms should the nurse monitor the client? SELECT ALL a. Hypovolemia b.Difficulty breathing c. Cardiovascular overload d. Pulmonary edema e. Hypoglycemia
b.Difficulty breathing c. Cardiovascular overload d. Pulmonary edema
After teaching a client about measures to reduce her risk for colon cancer, the nurse determines that the teaching was successful when the client states which of the following? a. "I will eat a diet high with lots of red meat." b. "I need to cut back on the amount of fruit I eat." c. "I should eat a half-cup of raisins every day." d. "I should avoid eating green leafy vegetables"
c. "I should eat a half-cup of raisins every day."
A client has just been diagnosed with lung cancer. After the physician discusses treatment options and leaves the room, the client asks the nurse how the treatment is decided upon. What would be the nurse's best response? a. "The type of treatment depends on the client's age and health status." b. "The type of treatment depends on what the client wants when given the options." c. "The type of treatment depends on the cell type of the cancer, the stage of the cancer, and the client's health status." d. "The type of treatment depends on the discussion between the client and the physician of which treatment is best."
c. "The type of treatment depends on the cell type of the cancer, the stage of the cancer, and the client's health status."
The nurse is caring for a client who has been diagnosed with colon cancer. When planning the client's care, the nurse should be aware of what function of the colon? Absorbing electrolytes b. Secreting digestive enzymes c. Absorbing large amounts of water d. Secreting bile
c. Absorbing large amounts of water
When performing the Team Leader role on a High-Performance team during a cardiac arrest, the Team Leader should be a. Initiates IV/IO access on the patient b. Records the time of interventions and medication administration c. Assigns roles to team members, makes treatment decisions and provides feedback to the rest of the team as needed d. Operates the AED/monitor/defibrillator and acts as the CPR Coach if designated
c. Assigns roles to team members, makes treatment decisions and provides feedback to the rest of the team as needed
A client is receiving care on the oncology unit for breast cancer that has metastasized to her lungs and liver. When addressing the client's pain in the plan of nursing care, the nurse should consider what characteristic of cancer pain? A. Cancer pain is often related to the stress of the client knowing she has cancer and requires relatively low doses of pain medications along with a high dose of anti-anxiety medications. b. Cancer pain is always chronic and challenging to treat, so distraction is often the best intervention. c. Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications. d. Cancer pain is often misreported by clients because of confusion related to their disease process.
c. Cancer pain can be acute or chronic and it typically requires comparatively high doses of pain medications.
Which nursing diagnosis is almost universally applicable to persons with depression? a. Ineffective denial b. Disturbed body image c. Chronic low self-esteem d. Risk for other-directed violence
c. Chronic low self-esteem
A nurse integrated the principles of evidence based practice into care. EBP has the potential to help the nurse achieve what goal? a. Increasing career satisfaction b. Obtaining federal grant money c. Ensuring high quality client care d. Enhancing the public's esteem for nursing
c. Ensuring high quality client care
Your patient has an ST-elevation myocardial infarction (STEMI) confirmed by an ECG completed in the emergency department. The patient had an onset of symptoms 7 hours ago. Your next step is: a. Consider admission to the ED chest pain unit or to an appropriate bed for further monitoring and possible intervention b. Check a second ECG to confirm a STEMI c. Prepare for percutaneous coronary intervention or fibrinolytic therapy d. Do nothing, the patient is out of the 3-hour window
c. Prepare for percutaneous coronary intervention or fibrinolytic therapy
A client experienced a 33% TBSA burn 72 hours ago. The nurse observes that the client's hourly urine output has been steadily increasing over the past 24 hours. How should the nurse best respond to this finding? a. Obtain an order to reduce the rate of the client's IV fluid infusion b. Report the client's early signs of acute kidney injury (AKI) c. Recognize that the client is experiencing an expected onset of diuresis d. Administer sodium chloride as prescribed to compensate for this fluid loss
c. Recognize that the client is experiencing an expected onset of diuresis
A client who was admitted for a heroin overdose received naloxone, which improved the breathing pattern. Two hours later, the client reports muscle aches, abdominal cramps, goosebumps and says, "I feel terrible." Which analysis is correct? a. The client is exhibiting a prodromal symptom of seizures b. An idiosyncratic reaction to naloxone is occurring c. Symptoms of opiate withdrawal are present d. The client is experiencing a relapse
c. Symptoms of opiate withdrawal are present
A client's screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this client's health problem? a. Adherence to a high-fiber diet will help the polyps resolve. b. The client should be assured that these are a normal, age-related physiologic change. c. The client's polyps constitute a risk factor for cancer. d. The presence of polyps is associated with an increased risk of bowel obstruction.
c. The client's polyps constitute a risk factor for cancer.
The intensive care nurse caring for a client in shock is planning assessments and interventions related to the client's nutritional needs. What physiologic process contributes to these increased nutritional needs? a. The use of albumin as an energy source by the body because of the need for increased adenosine triphosphate (ATP) b. The loss of fluids due to decreased skin integrity and decreased stomach acids due to increased parasympathetic activity c. The release of catecholamines that creates an increase in metabolic rate and caloric requirements d. The increase in GI peristalsis during shock and the resulting diarrhea
c. The release of catecholamines that creates an increase in metabolic rate and caloric requirements
The client diagnosed with ARDS is on a ventilator, and the high alarm is going off. The client is having respiratory difficulty, his oxygen saturation is 87%, and the nurse cannot determine the cause of the problem. Which intervention should the nurse implement first? a. Notify the respiratory therapist immediately. b. Auscultate the client's lung sounds. c. Ventilate with a manual resuscitation bag. d. Check the client's pulse oximeter reading.
c. Ventilate with a manual resuscitation bag.
1.) Margie Rand, RN, is caring for a patient who had a sudden episode of vomiting which produced 900 mL of frank blood. Margie directed and delegated to colleagues in order to notify the physician, start intravenous fluids, and provide physical and emotional support for the patient. Different situations call for different leadership styles. Which of the following leadership styles did Margie display in this situation? a. democratic b. laissez faire c. autocratic d. transformational
c. autocratic
The nurse is caring for a client who has the BRCA1 hereditary breast cancer gene mutation. What should the nurse teach the client about her risk for breast cancer? a.Breast cancer is an autosomal recessive inheritance in which each parent carries the gene mutation. b. Breast cancer is an X-linked inheritance and all males inherit an X chromosome from their mothers. c.Breast cancer has autosomal dominant inheritance that has incomplete penetrance and can skip a generation. d.Breast cancer has a pattern that is more horizontal than vertical; relatives of a single generation tend to have the condition.
c.Breast cancer has autosomal dominant inheritance that has incomplete penetrance and can skip a generation.
A 40-year-old male client is shocked to receive a diagnosis of mature B-cell lymphoma, and is doing research on his diagnosis on the Internet. Which statement that he reads on various websites is most reliable? a. "Like most forms of Hodgkin lymphoma, mature B-cell lymphoma often requires radiation treatment." b. "Doctors are able to diagnose mature B-cell lymphoma by the presence of Reed-Sternberg cells." c. "Unlike many other lymphomas, mature B-cell lymphoma is often self-limiting and treatment is focused on symptoms." d. "The lymph nodes are usually affected, and often the spleen and bone marrow."
d. "The lymph nodes are usually affected, and often the spleen and bone marrow."
A client with acute respiratory distress syndrome (ARDS) shows no improvement despite increases in the concentration of oxygen administered. What intervention should the nurse attempt which may improve ventilation-perfusion matching? a. Transfusion of packed red blood cells b. Infusion of albumin c. Positioning supine with head elevated 30 to 45 degrees d. Prone positioning
d. Prone positioning
A nurse researcher decides to conduct a qualitative research study. With which of the following would the researcher be involved? a. Collection of numerical data b. Determination of cause and effect c. Controlling personal biases d. Real world data collection
d. Real world data collection
An adult client has just been diagnosed with small cell lung cancer. The client asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurse's response? a. The cells in small cell cancer of the lung are not large enough to visualize in surgery. b. Small cell lung cancer is self-limiting in many clients and surgery should be delayed. c. Clients with small cell lung cancer are not normally stable enough to survive surgery. d. Small cell cancer of the lung grows rapidly and metastasizes early and extensively.
d. Small cell cancer of the lung grows rapidly and metastasizes early and extensively.
The nurse is providing care for a client who is withdrawing from heavy alcohol use. The nurse and other members of the care team are present at the bedside when the client has a seizure. In preparation for documenting this clinical event, the nurse should note which of the following? A. The ability of the client to follow instructions during the seizure. B. The success or failure of the care team to physically restrain the client. C. The client's ability to explain his seizure during the postictal period. D. The client's activities immediately prior to the seizure.
d. The client's activities immediately prior to the seizure.
